MEDICARE: DR. JEFFREY BETMAN PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	011960	MI

General Provider Information

NPI Number	:	1346375797
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEFFREY BETMAN PH.D.

Provider Business Mailing Address
First Line	:	27650 FARMINGTON RD
Second Line	:	SUITE 206
City	:	FARMINGTON HILLS
State	:	MI
Zip	:	48334-3350
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	27650 FARMINGTON RD
Second Line	:	SUITE 206
City	:	FARMINGTON HILLS
State	:	MI
Zip	:	48334-3350
Country	:	US
Telephone Number	:	248-324-9094
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/23/2007
Last Update Date	:	07/08/2007

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